When medical professionals, legal experts, health activists, and the officials of the Ministry of Health and Family Welfare meet here on Monday, on their agenda is a rather peculiar subject — rising cases of hysterectomies in India.
Hysterectomy is the complete or partial removal of the uterus, and sometimes ovaries, cervix and fallopian tubes. Ethically, a doctor should suggest this operation in case of certain medical conditions, or when all other treatment options fail.
“Although hysterectomy is one of the most common operations in gynaecological departments, it has recently been surrounded by controversies after there were reports from several States regarding needless hysterectomies being conducted on women in abnormally large numbers giving it all a projection of mass hysterectomies conducted by private medical practitioners in a spree to make more money,” says Chhaya Pachauli, a health activist with Chittoor-based non-governmental organisation called Prayas.
However, experts believe that with advances in medical science, the operation need not be a necessity. Women can opt for oral remedies, hormonal injections, intra-uterine devices and endometrial ablation to get rid of problems like heavy bleeding and fibroids. Experts also suggest that doctors should resort to this operation only when all other treatment options fail.
No exact statistics
While there are no exact statistics to show the prevalence rate of these operations in India, what is largely believed is that they are the second most common surgeries performed on women, second only to caesarean sections. They have become controversial lately because of an unusually large number performed on young women. The rising concern is not just about the high expenditure and medical ethics, but also about the complications and troubles that follow. Hysterectomy may have a significant impact on woman’s health.
A Right to Information Act (RTI) application filed in Dausa in Rajasthan revealed that between April and October 2010, out of a total of 385 operations reported by three private hospitals, 286 were hysterectomies. Many of these women were under the age of 30, with the youngest being 18.
Reports from Chhattisgarh and Bihar, too, highlighted the high number of hysterectomies being performed there and also linking them to the rollout of the Rashtriya Swasthya Bima Yojna (RSBY) insurance scheme. What makes the procedures more attractive is that being covered by the RSBY or other government sponsored insurance schemes, they are free.
“Women are neither informed about its long-term consequences, nor the alternative medical treatments available. Over 16,000 hysterectomies, most of them “unnecessary,” have been reported at private hospitals across Bihar during the last one year allegedly to “avail insurance benefit under the RSBY,” Ms. Pachauli explained.
In 2010, the Andhra Pradesh government had to tweak its State-sponsored insurance scheme to disallow hysterectomies in private hospitals after surveys revealed that uteruses of a number of beneficiaries were removed merely to claim higher insurance amounts.
“The objective of the consultation is to have informed deliberations around the issue in order to identify possible reasons which are driving large number of young women to have hysterectomies in the country, examine them through the lens of reproductive health rights and medical ethics and if required create firm ground for further advocacy and partnerships with different stakeholders to address the issue holistically,” according to a spokesperson of the Health Watch Trust which is organising the meeting.The issues to be taken up at the daylong consultation include discussion on evidence on incidence, indications, epidemiology, out-of-pocket expenditures on hysterectomy; role of professional associations for management of common uterine disorders; and the need for alternative/independent sources of information on hysterectomies
Another crucial study on hysterectomies was carried out to find out prevalence in a 2010 cross-sectional household survey of 2,214 rural and 1,641 urban, insured and uninsured women in low-income households in Ahmedabad city and district in Gujarat. The study, done by Sapna Desai, Tara Sinha, and Ajay Mahal and published in Reproductive Health Matters, investigated why hysterectomy was a leading reason for use of health insurance by women insured by SEWA, a women’s organisation that operates a community-based health insurance scheme. It was found that of insured women, 9.8 per cent of rural women and 5.3 per cent of urban women had had a hysterectomy, compared to 7.2 per cent and 4.0 per cent, respectively, of uninsured women. Approximately one-third of all hysterectomies were in women younger than 35. Rural women used the private sector more often for hysterectomy, while urban use was almost evenly split between the public and private sectors.
“The whole issue has now come under the purview of various women’s health rights advocates and what has raised eyebrows is the fact that many of these hysterectomies could have been avoided and that women are not given the whole story before they are taken for such life-altering surgery. Health rights advocates have even gone to the extent of regarding these incidents not just as a clear violation of reproductive health rights but also as a heinous crime and a form of violence on women,” Ms. Pachauli told The Hindu .